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Volume 14 No. 6 November-December, 2008		Print this article	PDF

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Get Rich Bang Bitch Child Custody Attorney Singlewomenadultservice Single Bg Travel 2006 Nov 05 Travellingsolo Escape2 Single Women Adult Service WHO EMRO - Eastern Mediterranean Health Journal

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usearchesearch wsearche Rich Bitch b Rich o Nov utsearchly Bang ncessary. Causes for agitation, such as pain, disorientation and delirium, are often not sought in NHs in Lebanon. Educating staff and enforcing policies will ensure that an NH resident is restrained only after full evaluation detailing all correctable causes of agitation [20]. The means of restraint should minimize any physical and emotional discomfort.

Fourth, state-dictated, national standards for NH care in Lebanon are an important part of ensuring a high level of quality care for NH residents. Mandatory regulations are needed to address technical issues such as the safety of NH buildings and facilities, record keeping, availability and quality of medical care, a standardized level of training of all staff, and the availability of professional staff at NHs. Homes unable to meet these requirements independently should be offered the necessary support to do so. We invite the MoPH, MoSA and PCNE to commission a task force to look into these aspects of elderly care in all NHs, after which they will be able to set standards, offer help to NH directors and staff and swiftly correct any aberrations noted in the system, as exemplified in other countries [21].

Lastly, intermediate care centres to rehabilitate elderly individuals in temporary need of medical care and physical therapy/
occupational therapy are of great importance. A recent field study by the Department of Epidemiology at the American University of Beirut surveyed the available intermediate rehabilitation services for older adults in Lebanon, finding many deficiencies in these services yet a great demand for them (Chaaya et al. unpublished data, 2006). Such facilities, when accompanied by a system of continuity of care, can offer the elderly the option of living at home while receiving all necessary medical care and social support [22].

The establishment of services that cater to elderly individuals living in the community and their caregivers is an essential component of improving the quality of elderly care in Lebanon. The efforts of MoSA are exemplary but to sustain and develop these services, mobilization of volunteers is important [23]. To ensure sustainability and efficiency, services should aim at becoming self-sufficient and independent of long-term governmental financial and logistic support. While government support is necessary for the establishment of social services, the community provides the backbone and the extension of government initiatives. Empowering the community to deliver these services is key to successful programmes. The establishment of various volunteer organizations with clear statements of purpose and goals will allow for specialized services and will address multiple aspects of elderly care. An elderly care system “by the people” will reflect standards of care based on the authentic needs of the community as its members perceive them.

As to elderly persons living alone, a home-based system of social, financial, nutritional and medical support is needed. Volunteer involvement could be of great benefit at many levels. Volunteers can establish and run senior citizens centres, elderly day-care centres and elderly services such as transportation, provision of meals to the elderly in their homes and support groups. Several models proven successful in other countries could be used as templates for Lebanon, such as the extra care housing system operating in the United Kingdom [21].

Last but not least are the strong family bonds and sense of duty and respect with which families regard their elderly family members in Lebanese society. This is indeed a great benefit for the Lebanese elderly. They continue to live at home for a longer period of time compared to older adults in Western countries. Educating
caregivers on the behavioural disturbances inherent in dementia, end-of-life issues and chronic illness will provide emotional and psychological support to caregivers, and enable them to care for their loved ones as long as possible [22]. For that purpose, support groups can be very helpful to the community. They are rare in Lebanon and respite care to relieve caregivers is non-existent. To change this, we invite all sectors to join forces in a national education campaign to implement these changes. We also recommend establishing telephone “hot-lines” and user-friendly websites that provide information on all aspects of ageing (including its causes, consequences and treatment), resources (as they become available) and medical care.

In this article, we have illustrated the shortcomings of the medical and social elderly care system in Lebanon and suggested steps that can be taken to improve it. We perceive that the changes proposed would occur at several equally important levels: government, medical/nursing community, NHs and the community. We acknowledge that Lebanon is a country in transition with limited resources. Thus, in terms of reform, we ought to implement changes needing the least resources first. Such changes can affect the system at several levels and start a chain reaction for further change. Later, the system could be modified by building on these primary changes, paralleling them (when resources become available) and complementing them when the moment is ripe. Key to the success of reforms is an in-depth analysis of the current situation, strong teamwork, the availability of grants for research, the refurbishment and improvement of existing facilities and the establishment of new ones. Lebanese society and physicians alike must be educated in all aspects of elderly care, and geriatric specialists from all fields are needed in numbers large enough to accommodate the increasingly ageing population. Lebanese society should embrace the elderly community and be their advocates, by establishing senior citizens programmes, senior transportation systems, efficient and sustainable volunteer programmes, and calling for legislation that guarantees each elderly individual his/her rights. The authors invite everyone to join the debate to establish a national charter for the elderly in Lebanon.

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